Risk of financial stressors in patients diagnosed with cancer: Lessons from a nationwide financial navigation program.
Authors: Andrea Incudine, Katharine Winder, Fitzgerald Draper, Thomas Stivers, Andrea Stern Ferris, Upal Kunal Basu Roy
Journal: Journal of Clinical Oncology (2023)

e18662 Background: Financial toxicity associated with a cancer diagnosis exacerbates the financial crisis in cancer patients and their families. Financial crisis is associated with poor outcomes due to both non-medical and medical hardships. Family Reach, a US-based nonprofit, is dedicated to removing financial barriers standing between cancer patients and their treatment through comprehensive financial navigation. In this study, we sought to understand the prevalence of medical and non-medical financial stressors in a Family Reach cohort. Methods: Patient application data (provided by patients, caregivers, or case workers) from the Family Reach program received between March 2020 and June 2022 were included in the analysis. Data included patient demographics, clinical attributes, financial attributes, and medical and non-medical financial stressors (described below). Significant associations between stressors and patient characteristics [X 2 test and Odds Ratios (OR)] are presented. Results: A total of 10,558 applications representing 50 states and D.C. were processed in the study period. Data was stratified by type of cancer (55% solid vs. 38% hematologic), age of patient (32% pediatric, 32% AYA, &amp; 36% adult), and patient race &amp; ethnicity [41% non-Hispanic White (W), 22% non-Hispanic Black (B), 16% Hispanic/Latinx (H/L)]. Ninety-two percent had annual household income &lt; $70,000 (US median -$70,784 in 2021). Race and ethnicity differences: Eighty-five percent B and 84% H/L patients had an annual household income &lt; $50,000, as compared to 65% W patients (X2p &lt; 0.05), and more likely to belong to single-parent households (59% B, 40% H/L, 30% W, X2 p &lt; 0.05). B and H/L patients were at a higher risk of food insecurity (B vs. W, OR = 1.8, H/L vs. W, OR = 1.9), utility shut-off (B vs. W, OR = 1.9, H/L vs. W, OR = 1.4), phone shut-off (B vs. W, OR = 2.0, H/L vs. W, OR = 1.2) and houselessness (B vs. W, OR = 1.8, H/L vs. W, OR = 1.7), compared to W patients, after adjusting for geography. Age of cancer onset: No income differences were observed between pediatric, AYA, &amp; adult patients. Adult (OR = 3.2) &amp; AYA (OR = 1.9) patients had a higher risk of unpaid medical expenses, as compared to pediatric patients, after adjusting for income &amp; geography. While no significant differences were noted between solid and heme cancers, lung patients were at a higher risk of financial distress from non-medical expenses (e.g., risk of homelessness OR = 1.4) as compared to breast, colon, and prostate combined, after adjusting for income &amp; geography. Conclusions: To our knowledge, this is the first analysis of financial stressors in a US national cohort of cancer patients and receiving financial navigation. The higher prevalence of financial stressors in patients of color in this self-selected group indicates that interventions addressing cancer need to integrate social determinants of health.